We review the state of evaluation within outcome-based commissioning in the United Kingdom. This is the first review to include empirical evaluations of both PbR and SIB programmes. We find a paucity of evaluation and that the quality of evaluations is not high. Moreover, studies tend to conflate the outcomes-based commissioning mechanism with the intervention or services that are funded, and are unable to assess the contribution of these separate elements to impact. Our review also highlights the challenges faced by evaluators in measuring social outcomes. We suggest ways to address these challenges.

Ewing's sarcoma family tumors (ESFT) are characterized by the presence of EWSR1-ETS fusion genes. Secondary chromosome changes are frequently described, although their clinical significance is not clear. In this study, we have collected and reviewed abnormal karyotypes from 88 patients with primary ESFT and a rearrangement of 22q12. Secondary changes were identified in 80% (70/88) of tumors at diagnosis. Multivariate analysis showed a worse overall and relapse free survival (RFS) for those with a complex karyotype (overall survival, P = 0.005; RFS, P = 0.04), independent of metastatic disease. Univariate survival analysis showed that a chromosome number above 50 or a complex karyotype was associated with a worse overall survival (>50 chromosomes, P = 0.05; complex karyotype, P = 0.04). There was no association between type of cytogenetic abnormality and the presence of metastatic disease at diagnosis. Univariate and multivariate survival analysis of a small subgroup with trisomy 20 indicated that trisomy 20 was associated with a worse overall and RFS. There was no difference in outcome associated with other recurrent trisomies (2, 5, 7, 8, or 12) or the common recurrent secondary structural rearrangements (deletions of 1p36, 9p12, 17p13, and 16q, and gain of 1q), although numbers were small. These data demonstrate the continued value of cytogenetics as a genome-wide screen in ESFT and illustrates the potential importance of secondary chromosome changes for stratification of patients for risk. Specifically, karyotype complexity appears to be a powerful predictor of prognosis, and the presence of trisomy 20 may be a marker of a more aggressive subset of this group.

Hospital‐acquired enteric infections, particularly those due to rotavirus, were investigated by studying 220 patients under 3 years of age who were admitted without gastroenteritis to two paediatric general medical wards during a 10 month period. Faecal specimens were collected within 48 h of admission and then daily until the patients were discharged. Samples were also collected after discharge if patients developed enteric symptoms within 2 days of discharge. Fourteen per cent (31 of 220) of patients acquired rotavirus infections while in hospital, 23% (seven of 30) excreted rotavirus only after discharge; 29% of patients infected with rotavirus were asymptomatic (nine of 31). Acquisition of rotavirus infection was most prevalent during the months May‐August, with a prevalence of 34% (12 of 35) in May. Hospitalization was prolonged in those patients who acquired rotavirus (11.1 days compared with 8.0 days, P < 0.05). This study highlights the importance of rotavirus as a cause of hospital cross‐infection, particularly in the very young patient, and emphasizes the need for further assessment of factors involved in its acquisition. In order to determine correctly the incidence of hospital‐acquired illness, it is essential to follow patients after discharge from hospital. This study reinforces the importance of developing preventive measures in order to reduce the frequency of this illness.

Based on the experience of evaluating two cross-age peer-tutoring interventions, we argue that researchers need to pay greater attention to causal mechanisms within the context of school-based randomised controlled trials. Without studying mechanisms researchers are less able to explain the underlying causal processes that give rise to results from randomised controlled trials. Studying implementation fidelity is necessary but not sufficient for causal explanation; the study of causal mechanisms through the application of mixed methods is also required. Due to the increasingly complicated nature of many classroom-based innovations that are subject to evaluation, and the potentially distal nature of hypothesised effects, particularly on attainment, programme theory and articulation of mechanisms are essential in enhancing causal explanation and promoting the accumulation of knowledge of what works and why in classroom settings.

This paper describes a cluster randomised controlled trial designed to test the efficacy of Eedi, a formative question setting and diagnostic digital platform, on attainment in mathematics at GCSE as well as its impact on teacher workload. The study is a pragmatic two arm trial that aims to randomise 180 English secondary schools to intervention and control (business as usual) conditions. The intervention is targeted at Year 10 pupils (aged 14-15 years) and their teachers commencing study of GCSE mathematics from September 2018 and will run for two years. The study is due to report at the end of 2021.

This chapter presents an analysis of the evaluation market in England. It examines the context within which evaluation takes place and the structure and dynamics of the evaluation marketplace. It charts the growth and retrenchment of demand for evaluation in England over the past 20 years or so, the diversity of commissioning arrangements, and the types of evaluation undertaken. The structure and dynamics of the supply side of the evaluation market in England over the past two decades are also considered. Specifically, these include the barriers to entry into the market, skill and expertise levels, training, professional regulation, and quality of outputs. The development of mergers, consortia, partnerships, and emergence of small‐scale evaluation companies are identified as significant trends on the supply side.

Research Protocol: A cluster randomised controlled trial to evaluate the Family SKILLS programme for reception year students from families in which English is an additional language Abstract: This paper describes a cluster randomized controlled trial of Family SKILLS, an intervention targeted at reception year children and their parents for whom English is an additional language. The trial will commence in the autumn of 2016 and run for one year. 155 primary schools in England will take part in the study. NatCen Social Research has been appointed to conduct the trial by the Education Endowment Foundation, the Bell Foundation and Unbound Philanthropy who are co-funding this research. The Family SKILLS intervention will be delivered by a number of delivery partner organisations coordinated by a consortium comprising Learning Unlimited, the Campaign for Learning and University College London, Institute for Education.

Patients diagnosed with acute pulmonary embolism (PE) are at an elevated risk for short-term mortality. An accurate prognostic model is important in guiding appropriate management. We aimed to use machine learning (ML) to predict 30-day all-cause mortality in patients diagnosed with acute PE. METHODS: 439 patients (48% men, 61AE15 years) diagnosed with acute PE at our institution were retrospectively analyzed. We included 101 variables from a range of domains including demographics, clinical, laboratory, echocardiographic, and CT imaging as candidate predictors. Machine learning algorithms including extreme gradient boosting (XGBoost), gradient boosting machine (GBM), random forest (RF), deep neural networks (DNN), and generalized linear models (GML) were evaluated on their classification performance and validated with 5-fold cross-validation. The PE severity index (PESI) and its simplified version (sPESI) were used as reference models. RESULTS: XGBoost was the best performing model in predicting 30-day all-cause mortality (AUC, 0.922 (95% confidence interval [